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Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial

AIMS : Fractional flow reserve (FFR(CT)) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFR(CT) would improve economic and clinical outcomes compared with s...

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Autores principales: Curzen, Nick, Nicholas, Zoe, Stuart, Beth, Wilding, Sam, Hill, Kayleigh, Shambrook, James, Eminton, Zina, Ball, Darran, Barrett, Camilla, Johnson, Lucy, Nuttall, Jacqui, Fox, Kim, Connolly, Derek, O’Kane, Peter, Hobson, Alex, Chauhan, Anoop, Uren, Neal, Mccann, Gerry, Berry, Colin, Carter, Justin, Roobottom, Carl, Mamas, Mamas, Rajani, Ronak, Ford, Ian, Douglas, Pamela, Hlatky, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648068/
https://www.ncbi.nlm.nih.gov/pubmed/34269376
http://dx.doi.org/10.1093/eurheartj/ehab444
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author Curzen, Nick
Nicholas, Zoe
Stuart, Beth
Wilding, Sam
Hill, Kayleigh
Shambrook, James
Eminton, Zina
Ball, Darran
Barrett, Camilla
Johnson, Lucy
Nuttall, Jacqui
Fox, Kim
Connolly, Derek
O’Kane, Peter
Hobson, Alex
Chauhan, Anoop
Uren, Neal
Mccann, Gerry
Berry, Colin
Carter, Justin
Roobottom, Carl
Mamas, Mamas
Rajani, Ronak
Ford, Ian
Douglas, Pamela
Hlatky, Mark
author_facet Curzen, Nick
Nicholas, Zoe
Stuart, Beth
Wilding, Sam
Hill, Kayleigh
Shambrook, James
Eminton, Zina
Ball, Darran
Barrett, Camilla
Johnson, Lucy
Nuttall, Jacqui
Fox, Kim
Connolly, Derek
O’Kane, Peter
Hobson, Alex
Chauhan, Anoop
Uren, Neal
Mccann, Gerry
Berry, Colin
Carter, Justin
Roobottom, Carl
Mamas, Mamas
Rajani, Ronak
Ford, Ian
Douglas, Pamela
Hlatky, Mark
author_sort Curzen, Nick
collection PubMed
description AIMS : Fractional flow reserve (FFR(CT)) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFR(CT) would improve economic and clinical outcomes compared with standard care. METHODS AND RESULTS : Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFR(CT) (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFR(CT). Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). CONCLUSION : A strategy of CTCA with selective FFR(CT) in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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spelling pubmed-86480682021-12-07 Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial Curzen, Nick Nicholas, Zoe Stuart, Beth Wilding, Sam Hill, Kayleigh Shambrook, James Eminton, Zina Ball, Darran Barrett, Camilla Johnson, Lucy Nuttall, Jacqui Fox, Kim Connolly, Derek O’Kane, Peter Hobson, Alex Chauhan, Anoop Uren, Neal Mccann, Gerry Berry, Colin Carter, Justin Roobottom, Carl Mamas, Mamas Rajani, Ronak Ford, Ian Douglas, Pamela Hlatky, Mark Eur Heart J Clinical Research AIMS : Fractional flow reserve (FFR(CT)) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFR(CT) would improve economic and clinical outcomes compared with standard care. METHODS AND RESULTS : Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFR(CT) (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFR(CT). Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). CONCLUSION : A strategy of CTCA with selective FFR(CT) in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography. Oxford University Press 2021-07-16 /pmc/articles/PMC8648068/ /pubmed/34269376 http://dx.doi.org/10.1093/eurheartj/ehab444 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Curzen, Nick
Nicholas, Zoe
Stuart, Beth
Wilding, Sam
Hill, Kayleigh
Shambrook, James
Eminton, Zina
Ball, Darran
Barrett, Camilla
Johnson, Lucy
Nuttall, Jacqui
Fox, Kim
Connolly, Derek
O’Kane, Peter
Hobson, Alex
Chauhan, Anoop
Uren, Neal
Mccann, Gerry
Berry, Colin
Carter, Justin
Roobottom, Carl
Mamas, Mamas
Rajani, Ronak
Ford, Ian
Douglas, Pamela
Hlatky, Mark
Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title_full Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title_fullStr Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title_full_unstemmed Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title_short Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
title_sort fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the forecast randomized trial
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648068/
https://www.ncbi.nlm.nih.gov/pubmed/34269376
http://dx.doi.org/10.1093/eurheartj/ehab444
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